HESI Medical-Surgical Nursing
Practice Questions and Answers (2026/2027) - Verified Answers
Perioperative | Fluid & Electrolyte | Cardiovascular | Hematologic & Oncologic | Respiratory | Neurological | Renal &
Endocrine | GI, Musculoskeletal & Emergency Care
Total Questions 130
Cognitive Mix 30% Recall | 50% Application | 20% Analysis
Question Style 75% Scenario-Based | 25% Direct Recall
Sections 8 (Perioperative through GI, Musculoskeletal & Emergency Care)
Scoring Standard Verified Answers against Current HESI and Med-Surg Standards
Audience Nursing Students preparing for HESI Med-Surg Specialty Exam
Edition 2026/2027 Curriculum-Aligned
This comprehensive HESI Medical-Surgical Nursing practice examination is structured to mirror the official HESI
Medical-Surgical Specialty Exam blueprint with 2026/2027 updated content reflecting current evidence-based practice
standards. Each question is presented with the verified correct answer and a detailed rationale grounded in
pathophysiological basis, assessment findings, nursing interventions, and safety priorities. Distractors are deliberately
constructed around common medical-surgical nursing errors: confusing fluid and electrolyte imbalances (hyperkalemia vs.
hypokalemia), misinterpreting ABG results, incorrect prioritization of unstable clients, overlooking postoperative
complications, confusing DKA with HHS, misidentifying transfusion reactions, improper medication administration, and
misapplying isolation precautions. High-yield HESI testing areas emphasized throughout: priority client assessment
(which client should the nurse assess first?), medication calculation and high-alert medication safety, ABG interpretation
with compensation assessment, postoperative complication recognition, blood transfusion reaction identification, left vs.
right heart failure differentiation, shock state recognition, and sepsis bundle implementation. Verification notes embedded
in each rationale confirm accuracy against current HESI and AACN medical-surgical standards to support A+ preparation.
Section 1: Perioperative Nursing Care
,Q1: A patient scheduled for an elective cholecystectomy asks the nurse to explain the risks of
surgery an hour after signing the consent. What is the nurse's best action?
A. Re-explain the risks and document the patient's understanding.
B. Notify the surgeon to re-explain the risks before the procedure. [CORRECT]
C. Tell the patient the form is already signed and proceed.
D. Cancel the surgery.
Correct Answer: B. Notify the surgeon to re-explain the risks before the procedure.
Rationale: Informed consent is the surgeon's legal responsibility; if the patient has unresolved questions, the nurse
must notify the surgeon. The nurse is the witness, not the explainer. Option A is out of nursing scope. Option C
violates autonomy. Option D overreacts. A+ verification: HESI tests the nurse's role as witness, not explainer, of
consent.
Q2: A patient scheduled for surgery at 8:00 AM asks if it is acceptable to have a sip of water with
morning medications. Which response is correct?
A. Yes, small amounts of clear liquids are allowed up to 2 hours before surgery per ASA guidelines.
[CORRECT]
B. No, all intake is prohibited after midnight.
C. Yes, only if the medication is for diabetes.
D. Yes, up to 1 hour before surgery.
Correct Answer: A. Yes, small amounts of clear liquids are allowed up to 2 hours before surgery
per ASA gu...
Rationale: ASA fasting guidelines: 8 hours for fatty meals, 6 hours for light meals, 2 hours for clear liquids. Most
facilities still require NPO after midnight but sips of water with essential morning meds may be permitted with
provider order. A+ verification: always verify institutional policy; ASA guidelines are evidence-based.
Q3: A preoperative patient reports taking aspirin 81 mg daily, metformin, and lisinopril. Which
medication is most concerning regarding perioperative bleeding risk?
A. Metformin.
B. Aspirin. [CORRECT]
C. Lisinopril.
D. All are safe to continue.
Correct Answer: B. Aspirin.
Rationale: Aspirin inhibits platelet aggregation for the lifespan of the platelet (7-10 days) and increases bleeding risk;
usually held 5-7 days before elective surgery per provider. Metformin is held day of surgery for risk of lactic acidosis.
Lisinopril may be held depending on facility. A+ verification: always consult provider and surgical team for
medication management.
,Q4: Preoperative teaching emphasizes incentive spirometry. Which instruction is most accurate?
A. Use the spirometer once daily after surgery.
B. Use incentive spirometry 10 times every hour while awake to prevent atelectasis.
C. Inhale deeply through the mouthpiece, hold for 3-5 seconds, then exhale slowly. [CORRECT]
D. Use only when feeling short of breath.
Correct Answer: C. Inhale deeply through the mouthpiece, hold for 3-5 seconds, then exhale
slowly.
Rationale: Correct technique: inhale slowly through mouthpiece, hold breath 3-5 seconds, exhale slowly; repeat 10
times every hour while awake. Options A, B, D are incorrect or partial. A+ verification: incentive spirometry prevents
postoperative atelectasis and pneumonia.
Q5: A preoperative patient states an allergy to latex with a history of anaphylaxis. Which
intervention is essential?
A. Place the patient in a standard OR with standard supplies.
B. Ensure a latex-free environment, notify the surgical team, and document the allergy prominently.
[CORRECT]
C. Apply latex gloves to verify the allergy.
D. Administer a prophylactic antihistamine only.
Correct Answer: B. Ensure a latex-free environment, notify the surgical team, and document the
allergy pro...
Rationale: Latex allergy requires a latex-free environment and notification of all surgical staff. Option A is unsafe.
Option C is dangerous. Option D is insufficient alone. A+ verification: latex allergy is a HESI high-yield safety topic.
Q6: During the surgical time-out before incision, what is the primary purpose?
A. To introduce the surgical team to the patient.
B. To verify correct patient, procedure, site, and laterality before incision. [CORRECT]
C. To discuss the surgical plan with family.
D. To complete the surgical consent.
Correct Answer: B. To verify correct patient, procedure, site, and laterality before incision.
Rationale: Time-out (Universal Protocol) verifies correct patient, procedure, site, and laterality immediately before
incision. The Joint Commission requires this for all invasive procedures. A+ verification: wrong-site surgery is a Never
Event; time-out prevents this.
, Q7: A patient in the PACU has a respiratory rate of 8/min, SpO2 88%, and is difficult to arouse.
What is the priority action?
A. Administer naloxone per protocol.
B. Reposition airway, encourage deep breathing, apply oxygen, and assess anesthesia administered.
[CORRECT]
C. Document and reassess in 15 minutes.
D. Discharge to the floor.
Correct Answer: B. Reposition airway, encourage deep breathing, apply oxygen, and assess
anesthesia admini...
Rationale: PACU respiratory depression is commonly opioid-related; airway repositioning, oxygen, and assessment
are first. Naloxone may be needed if unresponsive to stimulation and opioids were given. A+ verification: airway,
breathing, circulation (ABC) is always priority in PACU.
Q8: Which set of PACU discharge criteria indicates the patient is ready for transfer to the surgical
floor?
A. Aldrete score of 4 with stable vital signs and SpO2 92% on room air.
B. Aldrete score of 8-10 with stable vital signs, controlled pain, no bleeding, and adequate respiratory status.
[CORRECT]
C. Patient responsive to voice only.
D. BP 80/40 and HR 110.
Correct Answer: B. Aldrete score of 8-10 with stable vital signs, controlled pain, no bleeding, and
adequa...
Rationale: Aldrete score 8-10 (out of 10) along with stable vitals, controlled pain, and adequate respiration is required
for discharge. Option A is too low. Options C and D are unstable. A+ verification: Aldrete measures activity,
respiration, circulation, consciousness, oxygen saturation.
Q9: A patient 6 hours post-abdominal surgery is hesitant to ambulate. Which statement by the
nurse is most therapeutic and accurate?
A. Ambulation is optional; you can stay in bed.
B. Early ambulation prevents DVT, atelectasis, pneumonia, and ileus; we will help you walk a short distance
today. [CORRECT]
C. Wait until tomorrow to ambulate.
D. Ambulate only when pain is completely gone.
Correct Answer: B. Early ambulation prevents DVT, atelectasis, pneumonia, and ileus; we will help
you walk...
Rationale: Early ambulation prevents DVT, atelectasis, pneumonia, and ileus; the nurse assists with first ambulation.
Options A, C, D are incorrect and risk complications. A+ verification: ambulation should begin the evening of surgery
or POD#1 for most procedures.
Practice Questions and Answers (2026/2027) - Verified Answers
Perioperative | Fluid & Electrolyte | Cardiovascular | Hematologic & Oncologic | Respiratory | Neurological | Renal &
Endocrine | GI, Musculoskeletal & Emergency Care
Total Questions 130
Cognitive Mix 30% Recall | 50% Application | 20% Analysis
Question Style 75% Scenario-Based | 25% Direct Recall
Sections 8 (Perioperative through GI, Musculoskeletal & Emergency Care)
Scoring Standard Verified Answers against Current HESI and Med-Surg Standards
Audience Nursing Students preparing for HESI Med-Surg Specialty Exam
Edition 2026/2027 Curriculum-Aligned
This comprehensive HESI Medical-Surgical Nursing practice examination is structured to mirror the official HESI
Medical-Surgical Specialty Exam blueprint with 2026/2027 updated content reflecting current evidence-based practice
standards. Each question is presented with the verified correct answer and a detailed rationale grounded in
pathophysiological basis, assessment findings, nursing interventions, and safety priorities. Distractors are deliberately
constructed around common medical-surgical nursing errors: confusing fluid and electrolyte imbalances (hyperkalemia vs.
hypokalemia), misinterpreting ABG results, incorrect prioritization of unstable clients, overlooking postoperative
complications, confusing DKA with HHS, misidentifying transfusion reactions, improper medication administration, and
misapplying isolation precautions. High-yield HESI testing areas emphasized throughout: priority client assessment
(which client should the nurse assess first?), medication calculation and high-alert medication safety, ABG interpretation
with compensation assessment, postoperative complication recognition, blood transfusion reaction identification, left vs.
right heart failure differentiation, shock state recognition, and sepsis bundle implementation. Verification notes embedded
in each rationale confirm accuracy against current HESI and AACN medical-surgical standards to support A+ preparation.
Section 1: Perioperative Nursing Care
,Q1: A patient scheduled for an elective cholecystectomy asks the nurse to explain the risks of
surgery an hour after signing the consent. What is the nurse's best action?
A. Re-explain the risks and document the patient's understanding.
B. Notify the surgeon to re-explain the risks before the procedure. [CORRECT]
C. Tell the patient the form is already signed and proceed.
D. Cancel the surgery.
Correct Answer: B. Notify the surgeon to re-explain the risks before the procedure.
Rationale: Informed consent is the surgeon's legal responsibility; if the patient has unresolved questions, the nurse
must notify the surgeon. The nurse is the witness, not the explainer. Option A is out of nursing scope. Option C
violates autonomy. Option D overreacts. A+ verification: HESI tests the nurse's role as witness, not explainer, of
consent.
Q2: A patient scheduled for surgery at 8:00 AM asks if it is acceptable to have a sip of water with
morning medications. Which response is correct?
A. Yes, small amounts of clear liquids are allowed up to 2 hours before surgery per ASA guidelines.
[CORRECT]
B. No, all intake is prohibited after midnight.
C. Yes, only if the medication is for diabetes.
D. Yes, up to 1 hour before surgery.
Correct Answer: A. Yes, small amounts of clear liquids are allowed up to 2 hours before surgery
per ASA gu...
Rationale: ASA fasting guidelines: 8 hours for fatty meals, 6 hours for light meals, 2 hours for clear liquids. Most
facilities still require NPO after midnight but sips of water with essential morning meds may be permitted with
provider order. A+ verification: always verify institutional policy; ASA guidelines are evidence-based.
Q3: A preoperative patient reports taking aspirin 81 mg daily, metformin, and lisinopril. Which
medication is most concerning regarding perioperative bleeding risk?
A. Metformin.
B. Aspirin. [CORRECT]
C. Lisinopril.
D. All are safe to continue.
Correct Answer: B. Aspirin.
Rationale: Aspirin inhibits platelet aggregation for the lifespan of the platelet (7-10 days) and increases bleeding risk;
usually held 5-7 days before elective surgery per provider. Metformin is held day of surgery for risk of lactic acidosis.
Lisinopril may be held depending on facility. A+ verification: always consult provider and surgical team for
medication management.
,Q4: Preoperative teaching emphasizes incentive spirometry. Which instruction is most accurate?
A. Use the spirometer once daily after surgery.
B. Use incentive spirometry 10 times every hour while awake to prevent atelectasis.
C. Inhale deeply through the mouthpiece, hold for 3-5 seconds, then exhale slowly. [CORRECT]
D. Use only when feeling short of breath.
Correct Answer: C. Inhale deeply through the mouthpiece, hold for 3-5 seconds, then exhale
slowly.
Rationale: Correct technique: inhale slowly through mouthpiece, hold breath 3-5 seconds, exhale slowly; repeat 10
times every hour while awake. Options A, B, D are incorrect or partial. A+ verification: incentive spirometry prevents
postoperative atelectasis and pneumonia.
Q5: A preoperative patient states an allergy to latex with a history of anaphylaxis. Which
intervention is essential?
A. Place the patient in a standard OR with standard supplies.
B. Ensure a latex-free environment, notify the surgical team, and document the allergy prominently.
[CORRECT]
C. Apply latex gloves to verify the allergy.
D. Administer a prophylactic antihistamine only.
Correct Answer: B. Ensure a latex-free environment, notify the surgical team, and document the
allergy pro...
Rationale: Latex allergy requires a latex-free environment and notification of all surgical staff. Option A is unsafe.
Option C is dangerous. Option D is insufficient alone. A+ verification: latex allergy is a HESI high-yield safety topic.
Q6: During the surgical time-out before incision, what is the primary purpose?
A. To introduce the surgical team to the patient.
B. To verify correct patient, procedure, site, and laterality before incision. [CORRECT]
C. To discuss the surgical plan with family.
D. To complete the surgical consent.
Correct Answer: B. To verify correct patient, procedure, site, and laterality before incision.
Rationale: Time-out (Universal Protocol) verifies correct patient, procedure, site, and laterality immediately before
incision. The Joint Commission requires this for all invasive procedures. A+ verification: wrong-site surgery is a Never
Event; time-out prevents this.
, Q7: A patient in the PACU has a respiratory rate of 8/min, SpO2 88%, and is difficult to arouse.
What is the priority action?
A. Administer naloxone per protocol.
B. Reposition airway, encourage deep breathing, apply oxygen, and assess anesthesia administered.
[CORRECT]
C. Document and reassess in 15 minutes.
D. Discharge to the floor.
Correct Answer: B. Reposition airway, encourage deep breathing, apply oxygen, and assess
anesthesia admini...
Rationale: PACU respiratory depression is commonly opioid-related; airway repositioning, oxygen, and assessment
are first. Naloxone may be needed if unresponsive to stimulation and opioids were given. A+ verification: airway,
breathing, circulation (ABC) is always priority in PACU.
Q8: Which set of PACU discharge criteria indicates the patient is ready for transfer to the surgical
floor?
A. Aldrete score of 4 with stable vital signs and SpO2 92% on room air.
B. Aldrete score of 8-10 with stable vital signs, controlled pain, no bleeding, and adequate respiratory status.
[CORRECT]
C. Patient responsive to voice only.
D. BP 80/40 and HR 110.
Correct Answer: B. Aldrete score of 8-10 with stable vital signs, controlled pain, no bleeding, and
adequa...
Rationale: Aldrete score 8-10 (out of 10) along with stable vitals, controlled pain, and adequate respiration is required
for discharge. Option A is too low. Options C and D are unstable. A+ verification: Aldrete measures activity,
respiration, circulation, consciousness, oxygen saturation.
Q9: A patient 6 hours post-abdominal surgery is hesitant to ambulate. Which statement by the
nurse is most therapeutic and accurate?
A. Ambulation is optional; you can stay in bed.
B. Early ambulation prevents DVT, atelectasis, pneumonia, and ileus; we will help you walk a short distance
today. [CORRECT]
C. Wait until tomorrow to ambulate.
D. Ambulate only when pain is completely gone.
Correct Answer: B. Early ambulation prevents DVT, atelectasis, pneumonia, and ileus; we will help
you walk...
Rationale: Early ambulation prevents DVT, atelectasis, pneumonia, and ileus; the nurse assists with first ambulation.
Options A, C, D are incorrect and risk complications. A+ verification: ambulation should begin the evening of surgery
or POD#1 for most procedures.
